Provider Demographics
NPI:1508642299
Name:KING JOHNSON PERSONAL CARE SERVICES LLC
Entity Type:Organization
Organization Name:KING JOHNSON PERSONAL CARE SERVICES LLC
Other - Org Name:PERSONAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KING JOHNSON
Authorized Official - Middle Name:
Authorized Official - Last Name:GILUNGU
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:682-812-4249
Mailing Address - Street 1:48 BOWDOIN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-5605
Mailing Address - Country:US
Mailing Address - Phone:682-812-4249
Mailing Address - Fax:
Practice Address - Street 1:48 BOWDOIN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-5605
Practice Address - Country:US
Practice Address - Phone:682-812-4249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty